Six days post-surgery for the hair transplants, which means now that the follicles have been absorbed into their new locations, I no longer have to use the ultra-gooey antibiotic gel on my scalp, and I can wash away any of the remaining scabbing.

Unlike the prior letters from my medical doctors — which were strictly to try to get insurance to cover the surgery — this one is the critical one, since it means I’ve cleared the gatekeeping to get the surgery.

Because for better or worse, before you get GRS done, surgeons require you to get two letters** from your therapist/psychologist stating that you’re a “suitable” candidate for the surgery.

Since it’s a permanent, non-reversible surgery, I understand why surgeons want to make someone won’t have regrets (and potentially sue) later. OTOH, needless to say, the requirement also is at odds with the notion of patients having autonomy over their own bodies.

So yeah, getting the letter is a BFD.

#ShitsGettingReal

*Also known as “sexual reassignment surgery.”

(Please don’t refer to it as “sex change,” since that’s a outmoded term that most trans people find offensive as a verb, and definitely offensive when used as a noun, i.e. referring to trans people as “sex changes.”

**Dr. Suporn has his own psychologist do an evaluation when you arrive in Thailand, that psychologist writes the second letter. It’s usually a pro forma thing,*** but they could refuse to give you the green light if they have concerns.

***Dr. Suporn has a waiting list of well over year, and by that point you’ve paid a hefty non-refundable surgical fee, so you have to be pretty committed to doing the surgery by the time you arrive in Thailand for the evaluation.

Down in Beverly Hills, getting ready to do a third round of hair transplants. Unlike the first two, they’re not reshaping my hairline (it was changed to have a classically female upside down-U shape). Today it’s just filling two areas on the sides of my forehead that look really thin when I part my hair.

They’re going to use a different procedure this time. Instead of cutting out a strip of scalp as the donor for he transplanted follicles, this time they’ll be using the robotic method, where the robot exacts follicles individually.

The good news is that there won’t be an incision at the back of my head this time, and things should heal much faster.

The bad news is that they’ll need to shave at least two stripes 2cm wide in the back of my head, where the robot will be taking out follicles. Thankfully, the bare stripes aren’t visible afterwards because they’re covered by your other hair. However given how long it’s taken to grow out my hair, I’m still ready to cry whenever I think about it.

But as far as my transition, sacrifices must be made, and this is one of them.

I’ve intentionally been open about being trans, and about my transition, and I mostly respond with an “ask me anything” attitude. As Rachel, who is far, far more cool-as-fuck than I, aptly puts it:

“It’s mostly cool and okay when I answer questions about my life. I’m glad that I can be the first trans person that people meet (mostly). Because I’m cool as fuck and I’m willing to be patient and kind (mostly).”

But yeah… being constantly on call to do Trans 101 — usually not at times and places not of my own choosing — can be wearing.

As the fabulous Mx. Justin Vivian Bond put it: “it still feels like I can really only be myself when no one’s looking.” Mostly.

Got my official “referral for sexual reassignment surgery” letter from my physican today. It was a much more emotional moment than I would thought be.

Let me explain… This letter is simply to try to get insurance to cover the surgery.*

The letter that actually matters is the “gatekeeping” letter** I’ll be getting from my therapist shortly, saying that SRS is appropriate treatment for my gender dysphoria, that I’m not mentally ill or mentally impaired, and that I’m able to give informed consent. I can’t get surgery without it.

But still, even if it’s just “insurance paperwork,” this is a definite milestone. Shit’s getting real, real fast.

*Technically, California law requires insurers to cover SRS. But I’ll be having mine done in Thailand, which means paying upfront and then trying to get reimbursed your insurance company. Who usually do their best to avoid paying if you go overseas (which is ironic because the surgeons there are often better, and usually are less expensive).

I’m not that optimistic, but I’ve heard that the odds improve slightly if you get an referral from an in-network doctor, and seek pre-authorization. We’ll see…

**Surgeons typically require two therapists/psychologists to sign off your SRS, however, my surgeon has his own psychologist do the second evaluation, so I only need to get one letter myself.

I understand why surgeon’s want that sort of CYA, given that it’s an irreversible surgery. And certainly you’d be foolish to do without having done The Work about why you want it. (Which is true of any other plastic surgery). But yeah, it definitely poses issues around patients’ having autonomy over their bodies.